Federal Update: 1-27-20

The Medicare Payment Advisory Commission (MedPAC) recently recommended a 7 percent cut to the FY2021 base home health Medicare rate. The Commission also recommended eliminating a scheduled update to the FY2021 base payment rates for hospice. MedPAC also recommended an overhaul of the hospice cap, a complex payment cap that has so far had little impact on Vermont agencies. We join our national counterpart, the National Association for Home Care and Hospice (NAHC) in urging federal lawmakers not to accept these recommendations.
Medicare reimbursement is keeping Vermont’s Medicaid programs – like Choices for Care – afloat. Unfortunately, MedPAC – and CMS – want to reduce or eliminate Medicare margins. Their policy decisions are based on a national home health and hospice network that looks very different from Vermont’s not-for-profit, designated agency system.
Each January, MedPAC commissioners review the status of the Medicare program and discuss and vote on recommendations they will submit in a report to Congress in March. They look at factors such as access to care among Medicare beneficiaries and the amount and types of care being provided. In past years, the commission has recommended 5 percent cuts to home health payment rates; the extra two percentage points this year stem from the commissioners’ belief that previous reductions had not impacted care in the ways they had hoped.
In response to last week’s action by the Commission, NAHC President William A. Dombi noted, “Regarding the home health recommendations, we do not think that MedPAC has properly considered two main factors. First, home health utilization and spending is shrinking, not growing, at a time when a shift to community-based care is intensifying. That must mean something is wrong within Medicare policies that will be exacerbated with the recommended rate cuts. In addition, home health agencies just began the biggest change in their reimbursement model in two decades. The outcome of such is far from predictable. That means that cutting payment rates at such an unsettled time is a very high risk to care access.”
VNAs of Vermont will support NAHC’s efforts to work with Congress to protect the Vermonters we serve under the home health and hospice programs. We believe that diverting resources away from community-based care does not serve the population health goals of Vermont or our country.

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